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HomeMy WebLinkAbout0078 JAMES OTIS ROAD - Health 78 James Otis Road Centerville A = 170 - 102 5 M EAD� Nm Z•153WR UPC 12M4 emend com • Msde In USA .r0g) imft v _ TOWN OF BARNSTABLE LOCATION SEWAGE# ®® V4.LAGE ,�` ` 7 ASSESSOR'S MAP&PARCEL Z—�'—� G� INSTALLER'S NAME&PHONE NO. 41111 �'D SEPTIC TANK CAPACITY LEACHING FACILITY:(type),) _ ��� /' size) NO.OF BEDROOM��Spp OWNER (1/1C.Ivw4,Ck 7 � PERMIT DATE:, L COMPLIANCE DATE: Separation Distanc etw en the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility feet Private Water Supply Well and Leaching Facility(if any wells exist on site or within 200 feet of leaching facility) feet. .Edge of Wetland and Leaching Facility(if any wetlands exist ' within 300 feet of leaching facility). feet FURNISHED BY aL ems- ea � A 3 )33 No. 0 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplitation for Disposal *pstem Construction permit Application for a Permit to Construct( ) Repair.(/Upgrade( ) Abandon( ) ❑Complete System ndividual Components B Location Address or Lot No. S/UD Owner' Nair e,Address,and Tel.No. C.r t wgrc� X4G�tw�K Ltd Assessor's Map/Parcel Installer's a re s and Tel.No (���✓ Designer'sTNName,Address, A Tel.N �% Type of Building: Dwelling No.of Bedrooms Lot Size � sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided U gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank 1�; AA6p/ Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Healt Sighed ADate f Application Approved by ( GW Date S Application Disapproved by Date for the following reasons Permit No. 2.00 11, y(U Date Issued 14. Gj ---------------- —.ryyW_ti+w*+YY rr'�t.11a.+Y 1".�.-..�r.rw.ww�. - w.+..P•`•lY.��-WV1ti:.s..`,/M^�T"ft way.".r'-4.o�.:a. _.�ti a +F✓4'+rA'tv"..'�"�Is.ei.-.'a`d'.'IW4'.1.'wst•41Y'..l^'�•a^^"w5r{ +4Y4'tM"#:.'^" c.,l•..:w w.try{.Fl a;� a-�'.v.�.4.TH No. � —L lJ� ' -mil /a Fee THE COMMONWEALTH,OF MASSACHUSETTS Entered in computer: _. PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for Misposal *stem Construction Permit Application for a Permit to Construct( ) Repair,(/Upgrade( ) Abandon( ) ❑Complete System 04''ndividual Components Location Address or Lot No.79— 17 Aiv D /S ) Owner's Name,Address,and Tel.No. HMG,fh CK 1 6f(-,14 Assessor's Map/ParcelF, Installer's Name dre�s,and Tel No (�� /�7� Designer's Name,Address,and Tel.No ? 2 /y cG/ �lQ /�G , 1. SAS' �`v�3"--0//y �?Q� /— -362 'L__ Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building -j' No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �j�j U gpd Design flow provided U gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank /Z 5 /Oli G Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 22=!R� jL i1/�-�/ � T Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Healt . / I- S, d Date Application Approved by l• �. Date 5 Y r Application Disapproved by Date for the following reasons Permit No. Od Go Date Issued z uk U"1 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned( )by ZV,, ��/� at has been constructed in accordance i / p� with the provisions itle 5 anel' ie`fo isposal System Construction Permit No.-2GV q` GV dated /z U 1 Installer Designer #bedrooms :3 Approved design flow 3 v gpd The issuance of this Permit shall not be construed as a guarantee that the system will function -designed. Date i�� l 11 Inspector . Fee---���-^--------T . No. 60 —y�d THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE,,MASSACHUSETTS Misposal *pstem Construction permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this pe Date / 7D { Approved by �! J, 1 /1nt/l4`AAvA, �� C�.._�OUy �quv��, lJ� I /� r. APPLICANT: YrfLY1 �/( t'j✓ ADDRESS: 7 DESIGN FLOWN gpd REVIEWED BY: DATE: N/A OK NO Legal boundaries denoted [310 CMR 15.220(4)(a)] Street, Lot, tax parcel number and lot number noted on plan [3.10 CMR 15.220(4)(u)] X Locus Provided 310 CMR 15.2204 t Plan proper scale?(1"=40'for plot plans, 1"=20'or fewer for components) [310 CMR 15.220(4)] X Easements shown [310 CMR 15.220(4)(b)] X System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]-i not, a variance.is required 310 CMR 15.412(4)] X Location of impervious surfaces(driveways,parking areas etc.) [310 CMR 15.220(4)(d)]- X Location all buildings existing and proposed 310 CMR 15.220(4)(c)] X Location and dimensions of system components and reserve areas [310 CMR 15.220(4)(e)] System Calcu-lations [310 CMR 15.220(4)(f)] daily flow septic tank capacity (required and-Provided) X soil abso tion system (required andprovided) X whether system designed for garbage grinder North arrow [310 CMR 15.220(4)( )] Existing and ro osed contours [310 CMR 15.220(4)( )] Location and log of deep observation holes (existing grade el. on each test) 310 CMR 15.220(4)(h)] X Names of soil evaluator and BOH representative [310 CMR 15220(4)(h)and(i)] k Location and date of percolation tests (performed at proper elevation?) 310 CMR 15220(4)(i)] X Percolation test results match loading rate? [310 CMR 15.242] X , Certification statement by Soil Evaluator 310 CMR 15.220(4)(') Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3)and 310 CMR 15.220(4)(n)] Location of every water supply,public and private, [310 CMR 15220(4)(k)] �C Address 79 CS y[�S ��19 ✓1/`� Sheet l of 7 r 1 within 400 feet of the proposed system location in the case of surface water supplies and grgyel packed public water supply �( within 250 feet of the pioposed s stem location in the case within 150 feet of the proposed system location in the case , X of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. [310 CMR 15.220(4)(1)] . X Water lines-and atlieFsubsurface'utilities located [310 CMR 15.220 4 m) if water line cross see 310 CMR 15.211(1)[1 ) X Profile of system showing invert elevations of all system X components and the bottom of the SAS 310 CMR15.220(4)(o)] Stamp of designer 310 CMR 15.220 1 and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor(required if construction activities within 5 ft. of lot line) [310 CMR 15.220(3)] x Test Holes adequate(two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2)or as X approved for an upgrade under LUA at 310 CMR 15.405(1)(k Test hole.adequate to demonstrate four feet of suitable material? 310 CMR 15.103(4)] X Test Holes adequate to confirm adequate groundwater separation? . [310 CMR 15.103(3)] X Benchmark within 50-75'of system [310 CMR 15.220(4)( )] Materials specifications noted? [various sections of 310 CMR 15.000] X System components not>36" deep(unless Local Upgrade jApproval or LUA.requested) 310 CMR 15.405(1(b)] X Address �wt�°3 �f7S l.G''� ��� Sheet 2 of 7 Size OK? -[310 CMR 15.223(1)] Inlet tee located ten inches below flow line 310 CMR 15.227(6)] Outlet tee 14" or 14"+ 5"per foot for increase ft depth [310 CMR 15.227(6)] X Outlet tee with gas baffle or approved filter[310 CMR 15.227(4)] Note regarding.installation on stable compacted base [310 CMR 15.228(1)] Separation between inlet and outlet tees (no less than liquid de th) 310.CMR 15.227(2)] ly - Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permuted for upgrades under LUA [310 CW.15.405(1)(k)] X. Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 CMR 15.232(3)(f)] Three access covers (inlet and outlet must be 20" or greater) - X middle access at least 8" (b 7/07) [310 CMR 15.228(2)] Access to within 6 " of grade - one port for systems<1000gpd, two for systems>1000 gpd 310 CMR 15.228(2)] X All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] X > 10 ft from building foundation [310 CMR 15.211(1)] Buoyancy calculation Required/Done 310 CMR 15.221(8) H-20 Where appropriate? 310 CMR 15.226(3) Setbacks from resources 1310 CMR 15.2111X 0111, .Required when other than single-family.dwelling or flow>1000 d [310 CMR 15.223(1)(b)] X First compartment 200%daily flow; Second compartment 100% daily flow 310 CMR 15.224(2) and 3) "U"pipe through or over baffle, outlet of each compartment with as baffle or approved filter 310 CMR 15.224(4)] Address 70 ji4oVj 6 `s �; (�/'►' V��� Sheet 3 of 7 Located at least ten feet from any water line? [310 CMR 15.222(2)jX Disposal piping at least 18"below water line (when water and y sewer cross, see 310 CMR 15.21 l(1)[1]) �\ Cleanouts required/provided ? 310 CMR 15.222(8)] Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMR 15.222(6)] Proper pitch on all runs?(.005 within gravity-distributed trenches and beds) 310 CMR 15.251(9) and 310 CMR 15.252(2)(c) X Siphonproblem/ leachfield below jRump chamber Endca s or, manifolds ecified? Size and orientation of discharge holes specified?(not smaller than 3/8"not larger than 5/8") [310 CMR 15.251(8) and 310 CMR 15.252 2)(h)] Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) Stable compacted base [310 CMR 15.22](2)and 310 CMR 15.232(2)(a)] x Splash plate or baffle tee required on inlet/provided?(when pressure sewer to d-box or steep pitch of gravity sewer) [310 X CMR 15.323 3)(a)] Riser if deeper than 9 [310 CMR 15.232(3)(f)] Inside minimum dimension 12'.' 310 CMR 15.232(2)(b)] Minimum sum 6" [310 CMR15.232(3)(e)] Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] X Capacity(emergency.storage above working=design flow)?'[310 CMR 231(2)] X Proper setbacks 310 CMR 15.211 (same as septic tanks)] Watertight 20-in minium access manhole at least 20"MUST BE TO GRADE [310 CMR 15.231(5)] Service components accessible (not too deep,with piping, disconriects accessible) Alarm floats - alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating in lead-lag mode. [31-0,CMR 15.231(6)and (8)] ,4 Stable Corh acted Base [310 CMR 15.221(2)] Buoyancy calculations needed ?Provided? [310 CMR 15.221(8)] Address 6h S 6ei-sk-o 1lAe Sheet 4 of 7 Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1) Required separation-togroundwater? 310 CMR 15.212)] X .Aggregate specified as double washed [310 CMR 15.247(2)] System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.241) x Inspection ports specified and within 3"final grade? [310 CMR 15.240(13)] . X Breakout requirements met?(No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and y Guidance Document] Chambers and Gal. in trench configuration supplied with inlet every 20 ft. [310 CMR 15.253(6)] Each structure with one inspection manhole(if>2000 gpd must be tograde) 310 CMR 15.253(2)] X Aggregate 1'minimum-4'maximum. 310 CMR 15.253(1) ] 2'sidewall credit maximum [310 CMR 15.253(1)(a)] In bed configuration, inlet every 40 s ft. [310 CMR 15.253(6)] Width 2'minimum 3'maximum [310 CMR 15.251(1)(b)] 100 feet-maximum length 310 CMR 15.251 1) a Minimum separation 2x effective depth or width whichever eater(3x if reserve between trenches) [310 CMR 251 1)(d)] Situated alon contours [310 CMR 15.251(2)] Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document]` . minimum 2 distribution lines 310 CMR 15.252(2)(a)] LX Maximum separation between lines 6' 310 CM R15.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e) Aggregate depth below discharge pipes 6"minimum, 12" maximum. [310 CMR 15.252(2)( )] Separation between beds 10' minimum. [310 CMR 15.252(2)(f)] Bottom area used in calculations only 310 CMR 15.252(2)(i) Address l-TI meS (!�47,j � ����� 1 ' Sheet 5 of 7 Pressure Dosed System ? Provided pump and piping calculations as required 310 CMR 15:220 4 r)] Pressure dosing required on all systems>2000gpd or altemative systems undw-4trnedial approval [310 CMR 15.254(2) and VA X Remedial Use Approvals] If used in gravelless system - make sure jet is directed as not to scour soil interface [Guidance Document] X Inspections once per year(systems<2000 gpd)or quarterly X(>2000 dgood to*note on plan 310 CMR 15.254(2)(d)] Construction in fill -Did the plan specify that the fill shall meet the specification of 310 CMR 15.255(3)? X Impervious barrier and/or retaining wall ? Guidance Document] Impervious barrier installation must be supervised by x designer [310 CMR 15.25 5(2)(b)] Retaining wall must be designed by Registered Professional Engineer[310 CMR 15.255(2)(a)] '\ Side slope not exceed 3:1 ? 310 CMR 15.255(2) Breakout requirements met? [310 CMR 15.252(2) and Guidance Document X At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [3J0 CMR 15.255 (2)(e)] Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface Was DEP Approval Letter provided and/or have you reviewed the letter for conditions?. X Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for perpetual maintenance agreement? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has a2plicant submitted a co y of a maintenance Are the variances listed on the plan ? [310 CMR 15.220 ('4)(.) ,( RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] New construction or increased flow proposed - [Refer to 310 CMR 15.414] Address JT►MeS U1,f �jijf fP Sheet 6 of 7 ty � Is the system in a Designated Nitrogen Sensitive Area(Zone II for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and 310 CMR-15.216 - also refer to Policy regarding upgrades of such X existing systems] ' Is the system proposed on the same lot as served by private well ? (310 CMR 15.214(2)] X Are the nitrogen loads proposed in compliance? [310 CMR > 15.216(l)] \ Pumping to septic tank? 310 CMR 15.229 Shared System [310 CMR 15.290 Address 7e 47 WJ S Sheet 7 of 7 '` i Town of Barnstable �1HE � Regulatory Services Thomas F. Geiler,Director • aUuv MLL MAMAr a�,S Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 503-3624644 Fax: 503-790-6304 Installer & Designer Certification Form Date: t Sewage Permit#.W— �i�) Assessor's MapTarcel Designer:` : � Yfe(A e, &Y-� Installer: Address: Address: 7 On 1W11e was issued a permit to install a /Gate) (installer) �, septic system at -7®®® J,,q m--) / -4 based on a design drawn by (address) ii--V1 t� dated (designer) XI certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. r I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. OF �4AA��Zxl, DA ft N 4 . l, (Installers Signature)' " No 1140NITA D (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF CONIPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION THANK YOU Q: Health/Septic/Designer Certification Form 3-26-adoc I Town-of table Y .a p# . •� • Department dt Regulatory Services '.. I - •Date d 0 6t ! Publice 4Halth=Division s� , i4�¢ass i ZOO Mam Stree4 Hyunai3'MA'026U1 lfD IdA1 . Date Schedu _ led.. * , �'.�:5',� i= �. v •6�1 ,�i ..Fee�Pdt it t)� �:..� • . • i T. --�-�f Soil i S stab lity`Asses me;pit=for 5ewagii Disposal Performed By: � •' ! Witnessed B _-_ _T LOCATION&'GENER IAL'INFORMATION '']'� Owner's Name L,ocaddn Address_ V S /' /� j�,,� L-�vfJ Nt Q —�_ - - Address ��'JZ� es ��r<`l � ,� Ce.A vg wa '1 e c s 'e�'✓!` n Assessor's Map/P4rcei: I 7 �� Y Engineer's Natne'yj)a►°.'r:e- f t/ I 2Z NEW CONSIRU0170N REPAIR t Telephone# tiD Land Use �' Slopes Distances from: tJ Water Eod �D ft,PrPossible Wet Area;�J.'.1IL_ft Drinking Water Well ft pea 3 ,4 ..l - 'wr Zt. Drainage Way 7� ft Property lint! >,La ft "Other ft' SKETCH:(Street name,dimmsioos of lot.enact locations of trot holes&-pee tests.locate wetlands inproxitruty to holes)- 177.5? ft �/If'— --•----^\� —'�''��� Its- . LOT _.l L_ I ��\TH-2 ARC'4 _ 2$ M —1 1� D R I`G'E W A." 1:O I �-•-rt.ar --I II i77 _- -- O —i I �'1 z I g b _ . LI I z SERVCej I 11 I X r— Za rt 1� (No to g Le h P I-- 10) oc its Parent material(geologic) �"'""` Depth to Bedrock Wee in lYom Pit Face " Depth to Groundwater: Standing Water in Hole:' Weeping Estimated Seasonal49h Groundwater y3 � TION FOR SEAS oi"L HIGH WATL+'I�=T'Ar3I�+8 in. Method Used in in. =Depth to ball 111ott1C91: Depth (Ibperved standing) obs.hole: I� . °in, ©ruundwaterAdJuettneat Depth toiweeping from side of obs.hole: , !at for•,....�• AdJ:Or6undwater Leval.••.•.. Index Well# � Reading Date Index Well level r.. A • PERCOLAT IONq. Date --f-- , TA- Observation Time dt 9" 7 .A -- Note# -(' Tutu at 6" Depth of Pere D Y Time(991 _ Start Pre-soak Time.@ End Pre-soak Rate MinJlnch g 1 Y ? Aidditionai Testing Needed(YIN)—r— site Suitability Ass�smeCn �Sde Passed ; "Site Failedt - `- ° Observation Hole Data To Be Completed on'Back original:-.Public Hedlth Division f, ***If r ercola lion testis to be conducted within 100'of wetland,p1xol'to -You must fast notify the ('' �lcetrvation Division at least one(1)wedlc begu>un� DEEP OBSERVAI'IONHOLE LO,Gx Hole# soil per Dept,from Soil Norizon Soil Texture ;Sotl Color Mottling Structure.Stones,Boulders. Surface(in.) .(USDA) .(Mansell),. , ns t c vel 1d: N 14- 0 p ipl a DEEP OBSERVATION HOLESOG Hole# F e. Other Depth from. , Soil Horizon .Soil Texture Soll Color Soil (USDA) (Munsell) .Mottling _(Structure,Stones,Boulders... Suifacc n istenc 96 - 37 37!- DEEP'OBSERVATION-HOL&LOG .: . Hole#. Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. on i toOravell I i DEEP OBSER ION HOLE LOG Hole#�p Depth from Soil Horizon Soil ure Soil Color Soil they Surface(in.) (USDA) '(Munsell) Mottling (Structure,Stones,Boulders. consistency. • - ., �; -$,tit J Flood Insurance Rate Maa: _ __Atiove 500 year hood bo'undaijr_.No— Yes WithinS00yearboundany No.°ram Yes Within 100 year flood boundary No— Yti - TM Depth of Naturally Occurring Pervioin.Materlai- ' Does at'least'fourt&t of oaturally.occturing pe Ii is material exist in all areas observed throughout.the area proposed for the soil absorption system? If not what is the depth of naturally-occurring peAhous material? Certification Aqq I certify that on (date)I have passed the soil evaluator examination approved by the Department of vironmental Protection and that the above analysis was rperforrnedby me consistent with the required trainin ertise an experience described in 3.10 CM,�15 Ol T b Signature Date Q:1sEPf(.VERCFORM.DOC No FEic'- ....................... THE COMMONWEALTH orwAssAoxussrrs ��K~�J� ���� �� HEALTH ����^�" ^�� ��" " "��. .�� . . .......���u����?��-'-.x�F--l����� ���---------- - -n-n---~`--'--- for - '- r - --- Works Tonotrurtion P ' ' '' Application is hereby made for u Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal -' JO -----' ' -----------'r--'---'---'----'-'-----'----'------ . Laaation Address No. '---'-- _'--- _������� .........--. -������� - _- �� ��� - .. ... �����...----.--...... wn Address ...................... ��� ........................................... r------�-�n�^�r -���- Address Building Type of ~� Size ��''-� Sq. feetDvv�O�og--l�n. o� B�d,000`a---.--'.....----.------.Ezouooion Attic Garbage Grinder � Other—Typeof Building ............................ No. of yecaous------.--'--- Gbovvecu ( ) -- Cafeteria ~� ~~.Design Flow.........e742,4o......................gallons per person per day. Total daily flow......3.S.0......................... . 04 Septic Tank—Liquid capacity.. gallons Lcocdz Width Diameter ................ ` Disposal Trench --. .................... Width.................... Total- Length- ................... Total leaching area....................sq. '- � Seepage Pit .................... I}eor6 below Total ft. Z [t6ecDiotribxutioWbox ( ) Dosing tank ( ) � ~~ Percolation Test Results Performed by.......................................................................... I)ate----..-------------' Teat Pit No. l................noioutcsyerinch Depth of Test Pit.--'------' Depth to ground water..................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---------_-'-___'__'___--__---'----_---'---------'-----'_---'-'--_---- � u Description of Soil � | ---''--- � -------------.-_--.--_---_-------__---_'_-_.'--_--'------_'--_._-..-'_-_'_____. ~� Nature of Repairs or Alterations--Answer when applicable............................................................................................... � - --_---_.-_-_-_-- .TI undersigned agrees to install the aforedescribed. Individual Sewage Disposal System in accordance with t ep -isions 0 the State Sanitary Code—The undersigned further agrees not to place the system in Signed j/ate Dat Date Date —----------------- -' No .. .` Fas.... ,.� THE COMMONWEALTH OF MASSACHUSETTS 1' BOARD OF HEALTH - ....,....cY.".. ........... ......OF..........-.. ..............................---------------------.._.............._..._ Appliratiun for Dhipwial Works Tontitrur#inn Urrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at:,: / t......x�.�-... �..J'.. Mr...•x � C.. /� .................y i / ;.........Location-,Address........................... ......_...t' ..... ...............Lot No...�..................................... ......................t!-...... ...r. :f..i ..�. ....._.._._.............. .........__44 +4.ro :.=:::.....1:. f..r................................................. d� . 7 Owner, x!j Address Installer Address 4 Q Type of Building Size Lot_.__'_...::.1!°.`�..'--�___._ Sq. feet Dwelling—No. of Bedrooms...................3 ......................... Attic Garbage Grinder (/I)!j a,, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria a' Other fixtures .........................••---••--................. ..- S— ...................•_.Dsg - .._..gallons per person per day. Total daily flow......r= .._ ) ..gallons. 1:4 Septic Tank—Liquid capacity._/j:�'gallons Length................ Width................ Diameter---------------- Depth................ w Disposal Trench—No. .................. Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..}}C__C`_: :,_._-_-_ Diameter____________________ Depth below inlet................. Total leaching area................sq. ft. Z Other Distributiotl box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ pd ...................................-•-...-•-•-•-•...•••••••••••-••----•.........------••--..............--------...------......_..........------....-•.-•--- 0 Description of Soil........................................................................................................................................................................ W U w UNature of Repairs or Alterations—Answer when applicable............................................................................................... Agreen ent: T e undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with e ovisionS of T IT 'of the State Sanitary Code— The undersigned further agrees not to place the system in op atio u • a r rti- of Compliance has been issued by th�,.bo d of health. Signed .1t .....�...............................•------------------- U at ca Pero ed By-`--"="-..�_,�` r� �'�--._....... j�`:, =`- �� ......................... ....._....... Date PPlieation Disapproved for the following reasons---------------•.----.--•-•-•--------.--....---.--...--••-----------------------....._._.._........._..._._..... -------------------------------------•••.......•..........��•..••••••••........••••-•-•••-.......-----••••-•-•....................._....••-•••....----......-------------------------------- I I— Permit No.••••••-• �•----------------------- Issued........................ -5...---.......Dau------ Date ti THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF. A C�rr�ifirtt#le of f�uut�rlittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (\') or Repaired ( ) byr" ----------------------------------------------->/.... . y Installer at . p d`-••••••---•••••----•••••••••-••-•-••••-••••••••-•-••-•••-•-•••.....-----•••••--......---•••--•--•---•- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code a§ described in the application for Disposal Works Construction Permit No.... , .+ ....... dated------------f__ _ ....... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE... .. � --------------- Inspector------ ...................................................... THE THE COMMONWEALTH OF MASSACHUSETTS BOARD OF , .�. '''` ............................ Ole- No...U. .Sy.1..... OF.........:....... �iu�uuttl Turku �unu#rnnr�iun rrnti� Permission is hereby granted------.........D-a r...-••••--••---....••----•-•••••••••••-•-•••••••-......•••-•••••••••-•-•••••••.............•................ to Construct ( or Re air ( ) an Individual Sewage Disposal System f._ .. ••--.•.• Street as shown on the application for Disposal Works Construction Permit No --r1 .P__ Dated........ - ............... ....... ------------............................................................ �} / Board of Health DATE.........�•-`--1--~=------'"�-.........-.................................... FORM 1255 A. M. SULKIN, INC., BOSTON pEsi�w oA 7- S/N6LE F.4iy/L Y ^- 3 BE0�2oOM �-�__ A/O Gt A':-,84GE OA/LY FLOW = //O X 3 ToT.4L 1�.4/L}�FLolt/= �33D6•Po r OE,S/G�/ �E.eGOL4T/O�t/.2.4�• /"/.t/2�N/it/. ��LE� �� � //f M „o Q r a ',�}C.F p Pam] J-'.{;=� � `; L4 �1J J -�t � ► _ -_ --....,e�,...,_._ _�..�....d. . TEST All E v3 /dOQ ( f�.• O/ST. /it/t/. .� 2 6.aL BOX /N✓. /.y✓ 5�•G SE�G T,o,�sc G• ;, N/AriYEt7 .' $.�Z 5`,�''� �E,2T/F/EO PG OT PL/!i✓ Mtn. LOG.QT/OAS/ C�T�%��/.'L.L.•fs /. c•�/•� pfl Tom' /2-1 7- /3' t�= � Z-- / GE.er/Fy Tf/QT'THE to ZI i-),�-)O Tfo.cl ,SNovdv �c u r ;2✓i�v f�!G, /F�.rJ,�S f/E�EoN CGu1P�Y.s !�N/ /Tf/E S�OEL./NE B,exrF,e€',t/yE, ,,ve. ANO.fE'TBAG� ,eEQV/DEMENTS 4� Tf/� .eE6�-s�,P�'O.�-�`�L�-S!/,e✓Ey�S 41Vl9 /.S NOT' 44. L oc�rE.o WiTiY/N T.�✓E �Y QopP�,4iili ,4.�L/c�,c�r- � �' l Z-/7-�¢ �Cv�-� � ��j�,%�- � T//ls���v is .VoT 1�.4SEv o.✓,a.V/i�'SlSL- 1 Ta E.ST�L/S,y LoT L./N�'S L0 A1' ION ( 144 f 2F SWAGE PERMIT 010. 6 � ffS-3 1�'ILLAGE IMS A LLER'S NAME & ADDRESS 4,77 R U DE R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 65 a3- µS i/ V 04D BENCH MARK LEGEND c�Rogo PAINT SPOT ON ' � � j PROPOSED CONTOUR BULKHEAD CORNIER i� � ELEVATION = 58. 5` 5� t _ J �� L O T -3 4 q 1 ® PROPOSED SPOT GRADE BARh1STABLE GIS DATUM `�` A,RE�. _ I6896 f — ! -- 98 -- EXISTING CONTOUR + 96.52 EXISTING SPOT GRADE z TTH jj W— EXISTING WATER SERVICE N \\ �, I i TEST PIT 11.32I Z fi SITE LOCUS MAP N.T.S. �0, GENERAL NOTES• -U ;'• ��� �1 \\ ( l I. ALL CHANGES TO THIS PLAN MUST BE APPROVED Existing VED BY THE LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. g Leach Pits ii 2. ALL.WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS Z \ (Note 10) OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOCAL RULES AND REGULATIONS. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR \ GATE �Rv \ ` ' tt \ �� TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 5� 1 \\ �� U� I DESIGN ENGINEER. --- J \ _ ( 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 0 1 \ \ \ \ fn FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. ��\ 11 \ ` �� \\ - 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. -r \ o \ \ \ /_ \ 1 \ �\ v � `\ pQp�y �� � 8. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. n\\ 1\ \ \\ 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. \ 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 2\\. \ Exis tin g 1,000g - f\�•, --" 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY \ THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING Sep tic Tank \ CONSTRUCTION. \ ` - 10. EXISTING LEACH PIT TO BE PUMPED, CRUSHED AND FILLED PER TITLE V. \ L 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY - ' AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 13. NO PRIVATE WELLS WITHIN 100 FT. OF PROPOSED LEACHING 14. ALL PIPING TO BE 4" SCH 40 ® 1/8"/FT (UNLESS SPEC. OTHERWISE) \ 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW �� \\ 58 FOR THE USE OF A GARBAGE GRINDER 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING 17. PROPERTY IS IN ZONE II OR NITROGEN SENSITIVE AREA. { 17. INSTALLER TO FIELD VERIFY H2O CERTIFICATION PRIOR TO INSTALLATION. OF AIRRE 0 7} c Eta PROPOSED SEPTIC SYSTEM UPGRADE PLAN 1 S4NITA 0 ` 78 JAMES OTIS ROAD, CENTERVILLE, MA MAP:170 Prepared for: Mike Dedecko LOT. 102 SURVEY REFERENCE: Engineering by: Surveying by: SCALE DRAWN DEED BOOK.7398 DARRENM.MEYER,R.S. boo-Tech gerhwnmenta 1„=20' DMM PLAN OF LAND BY BAXTER & NYE, INC. DEED PAGE.•0157 PO BOX981 508 364-0894 DATE: CHECKED SHEET NO. 4 , EAST SANDWICH,MA 02537 DATED: MARCH 1 1960 508-3e2-1922 12/07/09 DMM 1 of 2 i as ' t NOTE: TO PREVENT BREAKOUT, THE PROPOSED NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:55.04 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. T.O.F. EL.=58.56 INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.) AND SET TO 3" OF F.G. OF Mq F.G. EL.=58.5t F.G. EL.=58.0t F.G. EL: 58.0t F.G. EL: 57.50-58.0(MAX.) �R�y�N IGIE ER L 1a'. 9" MIN COVER/ NO. 1140 L - 30' L = 10'(MAX) INSTALL TWO INSPECTION PORTS (MIN.) O S-1R (MIN.) 36 MAX COVER 0 S-1R (MIN.) 0 S-IX (MIN.), 4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC loll 11.3" To 2 11 MNITAR\�'� G� \INV."= 55.54 48'LIQUID 14 INVERT �a 1 LEVELINV.=55.29 � OAS BAFFLE INV.=54.75 4 ROWS OF 4 UNITS AT 6.25'/UNIT - "'/ROW l C�t Mk INV.=54• - INV.= 54.65 SOIL ABSORPTION SYSTEM (PROFILE) EXISTING 1,000 GALLON SEPTIC TANK RESTORE VEGETATIVE COVER EXISTING SEWER OUTLET LL WITH CLEAN PERC SANG 75" TO TO TO TOP OF CHAMBERS NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING {•, :.•; •. PIPE INVERTS PRIOR TO CONSTRUCTION 2) D-BOX SHALL BE SET LEVEL AND TRUE TO BREAKOUT=TOP ELEV.=55.04 GRADE ON A MECHANICALL COMPACTED SIX INV. ELEV.= 54.65 INCH CRUSHED STONE BASE, AS SPECIFIED IN BOTTOM ELEV.= 53.71 ulammEXISTING SUITABLE 310 CMR 15.221(2) 2.83 MATERIAL 3) INSTALL INLET & OUTLET TEES AS REQUIRED 5' MIN. ABOVE BOTTOM OF �,,. 76" - T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH 4 x 2.83 = 11.32 4) REPLACE EXISTING 1,000 GALLON SEPTIC (7.51' PROVIDED) USE 4 ROWS OF 4-HIGH CAPACITY PROFILE TANK WITH 1500 GALLON SEPTIC TANK BOTTOM OF TESTHOLE EL.=46.20 _ ADS BIODIFFUSER UNITS-NO STONE IF FAILED, DAMAGED, OR UNDERSIZED. SEPTIC SYSTEM PROFILE TYPICAL, SECTION T 16" N.T.S. H.Ps 11 DESIGN CRITERIA SOIL LOG P#: 12784 DATE: DECEMBER 7, 2009 34#1 I NUMBER OF BEDROOMS: 3 BEDROOMS SOIL EVALUATOR: DARREN M. MEYER, R.S., CSE #1614 SECTION END CAP SOIL TEXTURAL CLASS: CLASS I WITNESS: DAVE STANTON, BARNS B.O.H. DESIGN PERCOLATION RATE: <2 MIN/IN Elev. TP-1 Depth Elev. TP-2 Depth 16"" HIGH CAPACITY (H-20� BIODIFFUSER UNIT DAILY FLOW: 330 G.P.D. 57.87 A LOAMY SAND on 57.95 A LOAMY SAND 0" DESIGN FLOW: 330 G.P.D. 57.20 10YR 3/2 a a" 57.20 BJOYR 3/2 9" MODEL 16" HICAP LOAMY SAND LOAMY SAND LENGTH 76" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT GARBAGE GRINDER: NO (NOT DESIGNED FOR ARBAGE GRINDER) lOYR 6/e IOYR 6/8 EFFECTIVE LENGTH 75" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY PROPOSED SEPTIC TANK: USE EXISTING 1,00 GALLON CAPACITY 54.71 C1 38" 54.87 C1 37" SIDE WALL HEIGHT 11.2" DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. LEACHING AREA REQUIRED: (330) = 445.94 F. OVERALL HEIGHT 16" OVERALL WIDTH 34" 4640 7RUEMAN BLVD DISi RARYON BOX: OUTLETS MINIMUM MEDIUM SAND PERC 052.95 MEDIUM SANG HICLIARD,_OHIO, 43026 (MINIMUM) 2.5Y 6/6 ___ - ._ 13:6 CF Em _._ .PRIMARY SAS, - 2.5Y 6/6 CAPACITY (101.7 GAL) ADVANCED DRAINAGE SYSTEMS, INC. 4 ROWS OF 4 IFFUSER H-20 UNITS-NO STONEPROPOSED SEPTIC SYSTEM SITE PLAN BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.70 SF/LF OF BIODUFUSER) (BIODIFFUSERS) 16 UNITS x 6.25 LF x 4.70 SF/LF = 470 SF 46.20 140" 4"C- ,38" 78 JAMES OTIS ROAD, CENTERVILLE, MA DESIGN FLOW PROVIDED: 0.74(470 GPD/SF) = 347.80 GPD > 330 GPD req'd PERC RATE <2 MIN/IN. ("C" HORIZON) Prepared for: Mike Dedecko NO GROUNDWATER OBSERVED Engineering by: Surveying by: SCALE DRAWN DARRENM.MEYER,R.S. Roo-Teeb 8bvlronmenW NTS D.M.M. • 1, Oarren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 p0BOX981 (508) 364-0894 DATE:' CHECKED to conduct sail evaluations and that the above analysis has been performed by me consistent with the EAST SANDWICH,MA 02537 SHEET N0. requirements• 508.3B?292?of 310 CMR 15.017. 1 further certify that 1 have passed the Soil Eval. Exam in October, 1999. 12/07/09 D.M.M. 2 Of 2